Provider Demographics
NPI:1992826978
Name:GABRIELLE, VANESSA
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:GABRIELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 ARMOUR DRIVE
Mailing Address - Street 2:1207
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324
Mailing Address - Country:US
Mailing Address - Phone:404-444-5353
Mailing Address - Fax:
Practice Address - Street 1:415 ARMOUR DR NE
Practice Address - Street 2:1207
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3933
Practice Address - Country:US
Practice Address - Phone:404-444-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004408225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist